Prostate cancer medical white paper

ARIZONA PROSTATE CANCER
ASK FORCE REPORT
Office of the Director
(520) 626-7925
College of Med~cine
PO. Box 245024
Tucson, AZ 85724-5024
FAX: (520) 626-6898
November 15,2000
The Honorable Jim Weiers
Speaker of the House
Arizona House of Representatives
Capitol Complex
1700 West Washington
Phoenix, AZ 85007
Re: Report from the Prostate Cancer Task Force
Dear Speaker Weiers:
Attached is a copy of the inaugural report of the Prostate Cancer Task Force. On behalf of the
Task Force members, I am pleased to present this document to you. While it is very early in the
formal establishment of this group of individuals committed to eradicating prostate cancer, I
think the accomplishments after one formal meeting are notable.
If I can answer any questions or provide you with additional information, please contact me at
my office at 520-626-7925. Thank you for the opportunity to serve the State of Arizona in its
efforts to make a difference against this disease.
Professor of Medicine
Director, Arizona Cancer Center
ARIZONA CANCERC ENTER
a National Cancer Institute - designated comprehenslve cancer. center at The University of Arizona Health Sciences Center
Arizona Prostate Cancer Task Force Report
@ Introduction
P rostate cancer is the most common form of non-skin cancer in men in the United States. This
year alone it is estimated that 180,400 men will be diagnosed with prostate cancer and nearly
32,000 men will die of this disease. Because prostate cancer is associated with increasing age in males, it
is a particularly important problem in the State of Arizona, which has a relatively large retirement
population. In Arizona, prostate cancer represents the most common invasive cancer type with a crude
rate of 133.9 patients per 100,000 males.
While the etiology of prostate cancer is not known, the incidence of prostate cancer increases
with age. More than 75 percent of men diagnosed with prostate cancer are over age 65 years. African
American men and men with a family history of prostate cancer are at higher risk of developing the
disease.
In addition to its common occurrence, prostate cancer is characterized by its wide biologic
variability. This presents a difficult problem in managing the disease. While the disease remains organ
confined in most men, in some individuals there is rapid progression of the cancer with widespread bony
metastases and severe morbidity and mortality. Currently, there are no methods available to predict
those men with prostate cancer who are going to have aggressive tumors and require radical therapy,
versus those men with prostate cancer who have slow growing tumors that may never become clinically
apparent.
During 1992-1 996, prostate cancer mortality rates significantly declined in both white and black
men. Unfortunately, rates among black men remain twice as high as rates in white men. Overall,
survival rates for all stages of prostate cancer has increased from 67 percent to 92 percent, with 67 @ percent of men surviving for 10 years and 52 percent surviving for 15 years.
The establishment of a Prostate Cancer Task Force for Arizona provides a unique
opportunity to study and evaluate the impact that this disease is having on rlen in Arizona and
how we can make a difference against this disease. Currently in Arizona there are approximately
3,000 new cases of prostate cancer and approximately 600 deaths resulting from this disease.
Inaugural Meeting
T he Prostate Cancer Task Force held its first official meeting on September 14,2000 at the
Cancer Research Institute, Anzona State University. In addition to the Task Force, the
following individuals were in attendance: Michael Gordon from the Arizona Health Sciences
Center Phoenix Campus; Jack Knight, and Robin Pettit, and Bob Byars from the Cancer
Research Institute; Judy Bernas from the University of Arizona College of Medicine; Brian
McAnallen from the American Cancer Society and Laurie Young from the Arizona Cancer
Center.
In an effort to make a difference against prostate cancer in Arizona, the Task Force agreed on a
goal: To reduce the mortality ofprostate cancer by 50percent overjive years and by 90percent
over the next decade. To accomplish this goal, working teams to address specific areas of focus
were established. These working teams will focus on the mission of Task Force as outlined in
Arizona Prostate Cancer Task Force Report
the legislation. The teams include Research, Ways and Means, and Education/Informatics. Task
Force members and other interested parties volunteered to serve on one or more team.
Research Team
Team Leader: Michael Gordon
Team Members: Robin Pettit, Dan Von Hoff, Ralph Valle, Gordon Grado, Tom Fitch,
Gil Brito, Sid Rosen, Gloria Sanak, Brian McAnallen
T he Research Team discussed the need to establish an Arizona Prostate Cancer Tissue and
Serum Bank. Such a bank would ensure that both tissue and serum are available to apply the
latest molecular techniques to make a major impact against prostate cancer. The bank will lead to
the identification of therapeutic and prevention targets for prostate cancer. This will result in our
ability to more effectively treat patients with prostate cancer by identifying targets that separate
aggressive from non-aggressive cases.
We propose that the bank be established at the Arizona Cancer Center at Scottsdale Healthcare
Shea with particular attention to quality control. Since tumor specimens will be collected from a
variety of patients in different locations with different methods of tissue handling, it will be
critical to get this part of the bank set up correctly.
Our second focus will be to utilize the bank to test specific prognostic factors which can be used
to determine which patients might require more aggressive therapy, versus those who would not @ require extensive therapy. The first possible prognostic factor to be examined will be Trk A, a
marker which predicts which patients will have nerve invasion and, as a result, subsequent pain.
Lastly, using the bank, we will be able to identify new therapeutic and prognostic markers in
prostate cancer cells. The initial technology used to identify these targets will be microarray.
Indentification of these targets can lead to the development of new therapeutic agents through the
extensive drug discovery research efforts already taking place in Arizona.
To accomplish these goals, a grant entitled "Establishment of the Arizona Prostate Cancer Tissue
and Serum Bank for the purposes of improving life for men with prostate cancer," has been
submitted to the Arizona Disease Control Research Commission for funding consideration. The
grant is seeking $1 50,000 a year for three years. Proposal were due November 15,2000. Task
Force Members Dr. Daniel Von Hoff and Dr. Gil Brito, as well as Pathologists Dr. Peter Jolma,
of Scottsdale Healthcare, and Dr. Ray Nagle, of University Medical Center, will serve as
investigators on this grant. If funded, the start date would be July 1,200 1.
Other discussions by the Research Team included the potential need for men with prostate cancer
to have future studies done on their original tumor samples to determine if newly identified
prognostic factors are present . Tissue blocks of these tumors, taken at the time of original
surgery to remove the tumor, are stored by the Clinical Pathology Departments in hospitals. The
College of American Pathologists recommends that b locks be stored for five years. A survey of
Arizona hospitals should be conducted to determine the length of time tissue blocks are stored. It
@ may be necessary to enact legislation that would enable patients to obtain a representative block
Arizona Prostate Cancer Task Force Report
of their tumor before it is discarded after five years for future prognostic or therapeutic target
testing, as the current recommended storage time may no longer be adequate.
The incidence of prostate cancer is much lower among Hispanic men compared to incidence
rates among African American or white males. In Arizona, the crude incidence rate of prostate
cancer is 13 1 cases per 100,000 non-Hispanic males as compared to 71 cases per 100,000
Hispanic males. Another area of study that may be important would be to look at the protective
benefits among Hispanic men.
A statewide evaluation of available clinical trials for patients with advanced or relapsing prostate
cancer also is recommended. This would be an important resource for patients and their
physicians.
Ways and Means Team
Team Leader: April Becker Team Members: Gene Felker, Gordon Grado, Gil
Brito, Philip Poling
T he Ways and Means Team met to discuss possible funding sources other than those that
could potentially be made available through the Arizona Legislature. These resources would
be used to support programs and activities to be recommended by the Task Force to improve
andlor increase prostate cancer research, treatment, screening, public awareness, and public a education.
At this time, the committee suggests that surveying state agencies and community organizations
to determine what programs and resources are currently available in support of prostate cancer
awareness and education programs will provide the first steps in prioritizing what is needed in
our communities. Prioritizing of prostate cancer education and awareness programs will ensure
that available funding is applied in the order of importance and feasibility. The committee feels
that partnerships with the private sector as well as with companies with a vested interest in
prostate cancer may provide valuable opportunities for financial support.
In addition, a feasibility study should be conducted relative to the following potential funding
sources: the State Lottery, tobacco settlement dollars, funds raised through a "check-off box"
added to State Income Tax forms, and the possibility of initiating a "Conquer Cancer"
automobile license plate. Additional areas in which funding support could be sought include:
establishing a major annual fund-raising social event, exploring statewide funding support
through the United Way and the American Cancer Society, as well as through grant applications
to other charitable foundations, trusts, State and local commissions, corporations and individual
donors.
Education/Informatics Team
* Team Leader: Ralph Valle Team Members: Gregory Muhammad, Art Mollen, Gene Felker, Samuel Arutt,
April Becker, Gordon Grado, Tom Fitch, Rex Zeiger, Bert Chamberland
Arizona Prostate Cancer Task Force Report
@ To meet the goal agreed upon by the Task Force, the EducatiodInformatics Team recommends
the collection of accurate data regarding prostate cancer incidence and mortality, including racial
and ethnic distributions on a statewide basis where statistically appropriate. The Team suggests
that the Arizona Department of Health Services or a pertinent agency be contacted to gather
statistically appropriate data on the latest available incidence and mortality rates. The statewide
data should be defined by location, race and ethnicity.
Education and awareness are critical to making an impact on this disease. It would be important
to increase awareness about the risk factors and test for prostate cancer so that men can make
informed decisions about screening. The Education/Inforrnatics Team recommends that
$100,000 in public funds be appropriated for a community-based statewide education campaign.
The campaign should include:
1) Multi-media educational materials including brochures and posters, videos, computer-based
resources, and radio and television announcements.
2) An annual statewide symposium and local forums on prostate cancer
3) Newspaper articlesffeature stories
4) Radio and television talldcall-in programs (particularly for the Hispanic and African-
American communities).
5) Presentations to community groups (e.g. social and civic organizations, men's clubs
and lodges, fraternities, alumni associations, faith-based organizations, unions, and in
the workplace).
@ Part of the campaign should focus on men at high risk for prostate cancer (e.g. African-America
men and men with a family history of prostate cancer). Representatives from the general public,
prostate cancer survivors and health care professionals should be involved in planning for such a
campaign. Communication strategies and educational messages should be based on research that
demonstrates effective ways for reaching various racial and ethnic groups, age groups and
literacy groups.
Conclusion
P rostate cancer affects many Arizonans either directly or as a result of a diagnosis of a relative
or friend. While there are no funds currently appropriated to increase awareness of prostate
cancer, improve access to early detection techniques, or increase laboratory or clinical research
on prostate cancer, the Task Force is committed to studying ways to improve and/or increase
these areas of focus.
The Task Force will continue, through reports to the Governor, Speaker of the House and
President of the Senate, to provide updates of its findings as well as a perspective on how
Arizona is doing in the battle against prostate cancer from prevention through survival.
Arizona Prostate Cancer Task Force Report
@ List of Appendices
Prostate Cancer Task Force Legislation
Prostate Cancer Task Force Members
Prostate Cancer Task Force Meeting Minutes
Prostate Cancer Awareness Month Proclamation
Arizona Prostate Cancer Task Force Report
..........................
Conference Engrossed
State of Arizona
Senate
Forty-fourth Legislature
Second Regular Session
2000
..........................
SENATE BILL 1043
AN ACT
AMENDING TITLE 36, CHAPTER 1, ARTICLE 2, ARIZONA REVISED STATUTES, BY ADDING SECTION
36-142; RELATING TO THE DEPARTMENT OF HEALTH SERVICES.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 1, article 2, Arizona Revised Statutes, is amended by adding section 36-142, to read:
36-14? Prostate cancer task force; membership; duties; program termination
A. THE PROSTATE CANCER TASK FORCE IS ESTABLISHED CONSISTING OF THE FOLLOWING
MEMBERS:
I. THE DIRECTOR OF THE CANCER RESEARCH INSTITUTE AT ARIZONA STATE UNIVERSITY OR
THE DIRECTOR'S DESIGNEE. THIS MEMBER SHALL ACT AS CHAIRPERSON OF THE TASK FORCE IN
ODD-NUMBERED YEARS.
2. THE DIRECTOR OF THE ARIZONA CANCER CENTER AT THE UNIVERSITY OF ARIZONA OR THE
DIRECTOR'S DESIGNEE. THIS MEMBER SHALL ACT AS CHAIRPERSON OF THE TASK FORCE IN
EVEN-NUMBERED YEARS.
3 THE CHAIRPERSON OF THE ARIZONA DISEASE CONTROL RESEARCH COMMISSION OR A
MEMBER OF THAT COMMISSION DESIGNATED BY ITS CHAIRPERSON.
4. THE FOLLOWING MEMBERS WHO ARE APPOINTED BY THE GOVERNOR:
(a) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO
SPECIALIZES IN UROLOGY.
(b) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO
SPECiALlZES IN ONCOLOGY.
(c) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO
SPECIALIZES IN RADIATION ONCOLOGY.
(d) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO
SPECIALIZES IN INTERNAL MEDICINE.
(e) A PERSON WHO REPRESENTS A STATEWIDE ORGANIZATION THAT PROMOTES CANCER
AWARENESS.
( f ) TWO SURVIVORS OF PROSTATE CANCER.
(g) TWO REPRESENTATIVES OF THE BUSINESS COMMUNITY.
(h) TWO PUBLTC MEMBERS WITH A DEMONSTRATED INTEREST IN THE AREA OF EDUCATING THE
PUBLIC REGARDING THE RISKS AND PREVENTION OF CANCER.
5. TWO SURVIVORS OF PROSTATE CANCER. THE PRESIDENT OF THE SENATE AND THE SPEAKER
OF THE HOUSE OF REPRESENTATIVES SHALL EACH APPOINT ONE OF THESE MEMBERS.
6. TWO PUBLIC MEMBERS WITH A DEMONSTRATED INTEREST IN THE AREA OF EDUCATING THE
PUBLIC REGARDING THE RISKS AND PREVENTION OF CANCER. THE PRESIDENT OF THE SENATE
AND THE SPEAKER OF THE HOUSE OF REPRESENTATIVES SHALL EACH APPOINT ONE OF THESE
MEMBERS.
B. THE TASK FORCE SHALL:
1. MEET AT LEAST FOUR TIMES A YEAR AND AT THE CALL OF THE CHAIRPERSON.
2. COLLECT RESEARCH AND INFORMATION ON PROSTATE CANCER.
@ 3. EVALUATE VARIOUS APPROACHES USED BY STATE AND LOCAL GOVERNMENTS TO INCREASE
PUBLIC AWARENESS OF THE RISK, TREATMENT AND PREVENTION OF PROSTATE CANCER.
Arizona Prostate Cancer Task Force Report
4. STUDY WAYS TO IMPROVE COORDINATION BETWEEN AGENCIES AND INSTITUTIONS THAT ARE
INVOLVED IN RESEARCH AND TREATMENT OF PROSTATE CANCER.
5. STUDY WAYS TO INCREASE RESEARCH AND FUNDING AT STATE INSTITUTIONS THAT ARE
STUDYING CANCER.
6. STUDY WAYS TO INCREASE THE NUMBER OF MEN IN THIS STATE WHO ARE REGULARLY
SCREENED FOR PROSTATE CANCER.
7. IDENTIFY AREAS WHERE PUBLIC AWARENESS, PUBLIC EDUCATION, RESEARCH AND
COORDINATION ABOUT PROSTATE CANCER NEED IMPROVEMENT.
8. SUBMIT AN ANNUAL REPORT OF ITS FINDINGS AND RECOMMENDATIONS TO THE GOVERNOR,
THE SPEAKER OF THE HOUSE OF REPRESENTATIVES AND THE PRESIDENT OF THE SENATE ON OR
BEFORE NOVEMBER 15. THE TASK FORCE SHALL PROVIDE A COPY OF ITS REPORT TO THE
SECRETARY OF STATE AND THE DIRECTOR OF THE DEPARTMENT OF LIBRARY, ARCHIVES AND
PUBLIC RECORDS.
C. MEMBERS WHO SERVE PURSUANT TO SUBSECTION A, PARAGRAPHS 1 AND 2 OF THIS SECTION
SERVE FIVE YEAR TERMS AND MAY SERVE ONE ADDITIONAL TERM.
D. TASK FORCE MEMBERS ARE NOT ELIGIBLE TO RECEIVE COMPENSATION BUT MEMBERS WHO
SERVE PURSUANT TO SUBSECTION A, PARAGRAPHS 1 AND 2 OF THIS SECTION ARE ELIGIBLE TO
RECEIVE REIMBURSEMENT OF EXPENSES PURSUANT TO TlTLE 38, CHAPTER 4, ARTICLE 2 FROM
THEIR EMPLOYERS.
E. THE PROGRAM ESTABLISHED BY THIS SECTION ENDS ON JULY 1,2010 PURSUANT TO SECTION
41-3102.
Sec. 2. Initial terms of appointed members of the prostate cancer task force
A. Notwithstanding section 36-142, Arizona Revised Statutes, as added by this act, the initial terms of appointed
members are:
1. Two terms ending January 1, 2002.
2. Two terms ending January 1,2003.
3. Four terms ending January 1,2004. @ 4. Five terms ending January 1, 2005.
B. The governor, the speaker of the house of representatives and the president of the senate shall make all
subsequent appointments as prescribed by statute.
Sec. 3. Emergency
This act is an emergency measure that is necessary to preserve the public peace, health or safety and is operative
immediately as provided by law.
Arizona Prostate Cancer Task Force Report
Prostate Cancer Task Force Members
G. Robert Pettit, Ph.D. Director, Cancer Research Institute, ASU
Daniel Von Hoff, M.D., F.A.C.P. Director, Arizona Cancer Center, UA
Henry Reeves, Ph.D. Chair, Arizona Disease Control Research Commission
Governor Appointees
C. Gilberto Brito, M.D.
Tom Fitch, M.D.
Gordon Grado, M.D.
Art Mollen, D.O.
April Becker
Bert Chamberland, Ph.D.
Samuel Arutt
Gloria Sanak
Philip Poling
Rex Zeiger
Norman L. Miller
@ Speaker of House Appointees
Gregory Muhammad, M.D.
Appointment Area
Urology Specialist
Oncology Specialist
Radiation Oncology Specialist
Internal Medicine Specialist
Statewide Organization Promoting Awareness
Prostate Cancer Survivor
Prostate Cancer Survivor
Representative of Business Community
Representative of Business Community
Public Education - Cancer Risk and Prevention
Public Education - Cancer Risk and Prevention
Appointment Area
Public Education - Cancer Risk and Prevention
Ralph Valle Prostate Cancer Survivor
President of Senate Appointees Appointment Area
Sidney Rosen Public Education - Cancer Risk and Prevention
Gene Felker Prostate Cancer Survivor
Arizona Prostate Cancer Task Force Report
Prostate Cancer Taskforce Meeting Minutes
The inaugural meeting of the Prostate Cancer Task Force was held on Thursday, September 14,2000,
from noon to 2 p.m. at the Cancer Research Institute, Room 15 1, on the Arizona State University
Campus.
Members Present:
Samuel Arutt,
April Becker
Gil Brito, M.D.
Bert Chamberland, Ph.D.
Gene Felker
Tom Fitch, M.D.
Gordon Grado, M.D.
Art Mollen, D.O.
Members Absent:
Lee Miller
Greg Muhammad, M.D.
Philip Poling
Henry Reeves
Sidney Rosen
Gloria Sanak
Ralph Valle
Daniel Von Hoff. M.D., F.A.C.P
Rex Zeiger
G. Robert Pettit, Ph.D.
Attending for Members:
Jack Knight, Ph.D. for G. Robert Pettit, Ph.D.
@ Guests: Judy Bemas (University of Arizona College of Medicine)
~ r i a ~n c ~ n a l l(e~nm ericanC ancer society)
Robert Byars (Cancer Research Institute, Arizona State University (ASU))
Dr. Michael Gordon (Arizona Health Sciences Center, Phoenix Campus)
Jack Knight (Cancer Research Institute, ASU)
Robin Pettit (Cancer Research Institute, ASU)
Laurie Young (Arizona Cancer Center)
Facilitator:
Daniel Von Hoff, M.D., F.A.C.P.
Introductions and Certzjicate Distribution
The meeting began with a welcome from Dr. Von Hoff. He then asked everyone to introduce themselves ,
briefly describe their experience with prostate cancer and what they hope to see the task force accomplish.
Certificates from the Governor's Office were distributed to those members appointed by the Governor.
Charge from the Governor/Legislature
Dr. Von Hoff presented an overview of the incidence and mortality rates for prostate cancer in Arizona.
He then reviewed the mission of the task force as outlined in the legislation. There was a brief discussion
of the task force requirements and the fact that this is an unfunded mandate.
Arizona Prostate Cancer Task Force Report
Possible Methods to Approach the Charge
@ The Task Force agreed on a goal: To reduce the mortality ofprostate cancer by 50percent overfive
years and by 90percent over the next decade. To accomplish this goal, establishing working teams to
address areas of focus were recommended. The following teams were formed and members volunteered
to serve on one or more team.
Research Team
Team Leader: Michael Gordon
Team Members: Robin Pettit, Dan Von Hoff, Ralph Valle, Gordon Grado, Tom Fitch
Gil Brito, Sid Rosen, Gloria Sanak, Brian McAnallen
Action items: Establish a Prostate Cancer Tumor Bank (ADCRC Grant), study
protective benefits among Hispanic Men, "Keep the Tissue" legislation
to save tumor blocks, clinical trials for relapsing patients.
Ways and Means Team
Team Leader: Gene Felker
Team Members: April Becker, Gordon Grado, Gil Brito, Philip Poling
Action items: Fund raising opportunities, creation of an "Arizona Prostate Cancer
Action Plan (similar to New Jersey and Florida plans).
Informatics Team
Team Leader: Ralph Valle
Team Members: Gregory Muhammad, Art Mollen, Gene Felker, Samuel Arutt,
April Becker, Gordon Grado, Tom Fitch, Rex Zeiger, Bert Chamberland
Action Plan: Establish a web site with local clinical trials information, promote the
new SELECT study, increase awareness, increase usage of PSA, Prostate
Cancer Awareness Month, create a speakers bureau, prostate partners
plan (survivors and doctors meet with new patients).
Team leaders will organize their teams meetings. Team reports will be due to Dr. Von Hoff on Monday,
October 30,2000. From these team reports, a final report from the Task Force will be delivered to the
Governor's office by Wednesday, November 15,2000. It was proposed that the report be hand-delivered
to the Governor, the President of the Senate and the Speaker of the House by Dr. Von Hoff and the
Working Team Chairs. Further discussion of this recommendation will be done by phone as Nov. 15
approaches.
Another Meeting of the Task Force will be planned following the Nov. 15 deadline of the Task Force
Report to the Governor.
ADDENDUM TO THE MINUTES:
April Becker was asked by Gene Felker to replace him as Team Leader for the Ways and Means Team.
US TOO Prostate
-st Prostate Cmcer FoLmdatmn, and the
Sadhwst DNism of the Amencan Ca deckated to pnxmbng awareness, infonatron and
assistance to Anuxra's cibzens of this dre
i,' 2
MW,T HEREFORE, I, Jane Dee M, ~ o u h r && State of Arizona, do hemby prodakn September,
MOO as : fjd
; 3
PROSTATE C~WMAW ARENEW MWlli
=.
IN WTNESS WHEREOf, I have tmretmto set my hand and
cacfted to be Mixed the Great Seal of the State of Arizona I
/ . GOVERNOR
DONE at #e Qpii in PMenix on this eleventh day of
September in the vear Two Thousand and of the
? ~nde~endencoef the-united States of America the Two I
Hundred and Twenty-fowth. I

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ARIZONA PROSTATE CANCER
ASK FORCE REPORT
Office of the Director
(520) 626-7925
College of Med~cine
PO. Box 245024
Tucson, AZ 85724-5024
FAX: (520) 626-6898
November 15,2000
The Honorable Jim Weiers
Speaker of the House
Arizona House of Representatives
Capitol Complex
1700 West Washington
Phoenix, AZ 85007
Re: Report from the Prostate Cancer Task Force
Dear Speaker Weiers:
Attached is a copy of the inaugural report of the Prostate Cancer Task Force. On behalf of the
Task Force members, I am pleased to present this document to you. While it is very early in the
formal establishment of this group of individuals committed to eradicating prostate cancer, I
think the accomplishments after one formal meeting are notable.
If I can answer any questions or provide you with additional information, please contact me at
my office at 520-626-7925. Thank you for the opportunity to serve the State of Arizona in its
efforts to make a difference against this disease.
Professor of Medicine
Director, Arizona Cancer Center
ARIZONA CANCERC ENTER
a National Cancer Institute - designated comprehenslve cancer. center at The University of Arizona Health Sciences Center
Arizona Prostate Cancer Task Force Report
@ Introduction
P rostate cancer is the most common form of non-skin cancer in men in the United States. This
year alone it is estimated that 180,400 men will be diagnosed with prostate cancer and nearly
32,000 men will die of this disease. Because prostate cancer is associated with increasing age in males, it
is a particularly important problem in the State of Arizona, which has a relatively large retirement
population. In Arizona, prostate cancer represents the most common invasive cancer type with a crude
rate of 133.9 patients per 100,000 males.
While the etiology of prostate cancer is not known, the incidence of prostate cancer increases
with age. More than 75 percent of men diagnosed with prostate cancer are over age 65 years. African
American men and men with a family history of prostate cancer are at higher risk of developing the
disease.
In addition to its common occurrence, prostate cancer is characterized by its wide biologic
variability. This presents a difficult problem in managing the disease. While the disease remains organ
confined in most men, in some individuals there is rapid progression of the cancer with widespread bony
metastases and severe morbidity and mortality. Currently, there are no methods available to predict
those men with prostate cancer who are going to have aggressive tumors and require radical therapy,
versus those men with prostate cancer who have slow growing tumors that may never become clinically
apparent.
During 1992-1 996, prostate cancer mortality rates significantly declined in both white and black
men. Unfortunately, rates among black men remain twice as high as rates in white men. Overall,
survival rates for all stages of prostate cancer has increased from 67 percent to 92 percent, with 67 @ percent of men surviving for 10 years and 52 percent surviving for 15 years.
The establishment of a Prostate Cancer Task Force for Arizona provides a unique
opportunity to study and evaluate the impact that this disease is having on rlen in Arizona and
how we can make a difference against this disease. Currently in Arizona there are approximately
3,000 new cases of prostate cancer and approximately 600 deaths resulting from this disease.
Inaugural Meeting
T he Prostate Cancer Task Force held its first official meeting on September 14,2000 at the
Cancer Research Institute, Anzona State University. In addition to the Task Force, the
following individuals were in attendance: Michael Gordon from the Arizona Health Sciences
Center Phoenix Campus; Jack Knight, and Robin Pettit, and Bob Byars from the Cancer
Research Institute; Judy Bernas from the University of Arizona College of Medicine; Brian
McAnallen from the American Cancer Society and Laurie Young from the Arizona Cancer
Center.
In an effort to make a difference against prostate cancer in Arizona, the Task Force agreed on a
goal: To reduce the mortality ofprostate cancer by 50percent overjive years and by 90percent
over the next decade. To accomplish this goal, working teams to address specific areas of focus
were established. These working teams will focus on the mission of Task Force as outlined in
Arizona Prostate Cancer Task Force Report
the legislation. The teams include Research, Ways and Means, and Education/Informatics. Task
Force members and other interested parties volunteered to serve on one or more team.
Research Team
Team Leader: Michael Gordon
Team Members: Robin Pettit, Dan Von Hoff, Ralph Valle, Gordon Grado, Tom Fitch,
Gil Brito, Sid Rosen, Gloria Sanak, Brian McAnallen
T he Research Team discussed the need to establish an Arizona Prostate Cancer Tissue and
Serum Bank. Such a bank would ensure that both tissue and serum are available to apply the
latest molecular techniques to make a major impact against prostate cancer. The bank will lead to
the identification of therapeutic and prevention targets for prostate cancer. This will result in our
ability to more effectively treat patients with prostate cancer by identifying targets that separate
aggressive from non-aggressive cases.
We propose that the bank be established at the Arizona Cancer Center at Scottsdale Healthcare
Shea with particular attention to quality control. Since tumor specimens will be collected from a
variety of patients in different locations with different methods of tissue handling, it will be
critical to get this part of the bank set up correctly.
Our second focus will be to utilize the bank to test specific prognostic factors which can be used
to determine which patients might require more aggressive therapy, versus those who would not @ require extensive therapy. The first possible prognostic factor to be examined will be Trk A, a
marker which predicts which patients will have nerve invasion and, as a result, subsequent pain.
Lastly, using the bank, we will be able to identify new therapeutic and prognostic markers in
prostate cancer cells. The initial technology used to identify these targets will be microarray.
Indentification of these targets can lead to the development of new therapeutic agents through the
extensive drug discovery research efforts already taking place in Arizona.
To accomplish these goals, a grant entitled "Establishment of the Arizona Prostate Cancer Tissue
and Serum Bank for the purposes of improving life for men with prostate cancer," has been
submitted to the Arizona Disease Control Research Commission for funding consideration. The
grant is seeking $1 50,000 a year for three years. Proposal were due November 15,2000. Task
Force Members Dr. Daniel Von Hoff and Dr. Gil Brito, as well as Pathologists Dr. Peter Jolma,
of Scottsdale Healthcare, and Dr. Ray Nagle, of University Medical Center, will serve as
investigators on this grant. If funded, the start date would be July 1,200 1.
Other discussions by the Research Team included the potential need for men with prostate cancer
to have future studies done on their original tumor samples to determine if newly identified
prognostic factors are present . Tissue blocks of these tumors, taken at the time of original
surgery to remove the tumor, are stored by the Clinical Pathology Departments in hospitals. The
College of American Pathologists recommends that b locks be stored for five years. A survey of
Arizona hospitals should be conducted to determine the length of time tissue blocks are stored. It
@ may be necessary to enact legislation that would enable patients to obtain a representative block
Arizona Prostate Cancer Task Force Report
of their tumor before it is discarded after five years for future prognostic or therapeutic target
testing, as the current recommended storage time may no longer be adequate.
The incidence of prostate cancer is much lower among Hispanic men compared to incidence
rates among African American or white males. In Arizona, the crude incidence rate of prostate
cancer is 13 1 cases per 100,000 non-Hispanic males as compared to 71 cases per 100,000
Hispanic males. Another area of study that may be important would be to look at the protective
benefits among Hispanic men.
A statewide evaluation of available clinical trials for patients with advanced or relapsing prostate
cancer also is recommended. This would be an important resource for patients and their
physicians.
Ways and Means Team
Team Leader: April Becker Team Members: Gene Felker, Gordon Grado, Gil
Brito, Philip Poling
T he Ways and Means Team met to discuss possible funding sources other than those that
could potentially be made available through the Arizona Legislature. These resources would
be used to support programs and activities to be recommended by the Task Force to improve
andlor increase prostate cancer research, treatment, screening, public awareness, and public a education.
At this time, the committee suggests that surveying state agencies and community organizations
to determine what programs and resources are currently available in support of prostate cancer
awareness and education programs will provide the first steps in prioritizing what is needed in
our communities. Prioritizing of prostate cancer education and awareness programs will ensure
that available funding is applied in the order of importance and feasibility. The committee feels
that partnerships with the private sector as well as with companies with a vested interest in
prostate cancer may provide valuable opportunities for financial support.
In addition, a feasibility study should be conducted relative to the following potential funding
sources: the State Lottery, tobacco settlement dollars, funds raised through a "check-off box"
added to State Income Tax forms, and the possibility of initiating a "Conquer Cancer"
automobile license plate. Additional areas in which funding support could be sought include:
establishing a major annual fund-raising social event, exploring statewide funding support
through the United Way and the American Cancer Society, as well as through grant applications
to other charitable foundations, trusts, State and local commissions, corporations and individual
donors.
Education/Informatics Team
* Team Leader: Ralph Valle Team Members: Gregory Muhammad, Art Mollen, Gene Felker, Samuel Arutt,
April Becker, Gordon Grado, Tom Fitch, Rex Zeiger, Bert Chamberland
Arizona Prostate Cancer Task Force Report
@ To meet the goal agreed upon by the Task Force, the EducatiodInformatics Team recommends
the collection of accurate data regarding prostate cancer incidence and mortality, including racial
and ethnic distributions on a statewide basis where statistically appropriate. The Team suggests
that the Arizona Department of Health Services or a pertinent agency be contacted to gather
statistically appropriate data on the latest available incidence and mortality rates. The statewide
data should be defined by location, race and ethnicity.
Education and awareness are critical to making an impact on this disease. It would be important
to increase awareness about the risk factors and test for prostate cancer so that men can make
informed decisions about screening. The Education/Inforrnatics Team recommends that
$100,000 in public funds be appropriated for a community-based statewide education campaign.
The campaign should include:
1) Multi-media educational materials including brochures and posters, videos, computer-based
resources, and radio and television announcements.
2) An annual statewide symposium and local forums on prostate cancer
3) Newspaper articlesffeature stories
4) Radio and television talldcall-in programs (particularly for the Hispanic and African-
American communities).
5) Presentations to community groups (e.g. social and civic organizations, men's clubs
and lodges, fraternities, alumni associations, faith-based organizations, unions, and in
the workplace).
@ Part of the campaign should focus on men at high risk for prostate cancer (e.g. African-America
men and men with a family history of prostate cancer). Representatives from the general public,
prostate cancer survivors and health care professionals should be involved in planning for such a
campaign. Communication strategies and educational messages should be based on research that
demonstrates effective ways for reaching various racial and ethnic groups, age groups and
literacy groups.
Conclusion
P rostate cancer affects many Arizonans either directly or as a result of a diagnosis of a relative
or friend. While there are no funds currently appropriated to increase awareness of prostate
cancer, improve access to early detection techniques, or increase laboratory or clinical research
on prostate cancer, the Task Force is committed to studying ways to improve and/or increase
these areas of focus.
The Task Force will continue, through reports to the Governor, Speaker of the House and
President of the Senate, to provide updates of its findings as well as a perspective on how
Arizona is doing in the battle against prostate cancer from prevention through survival.
Arizona Prostate Cancer Task Force Report
@ List of Appendices
Prostate Cancer Task Force Legislation
Prostate Cancer Task Force Members
Prostate Cancer Task Force Meeting Minutes
Prostate Cancer Awareness Month Proclamation
Arizona Prostate Cancer Task Force Report
..........................
Conference Engrossed
State of Arizona
Senate
Forty-fourth Legislature
Second Regular Session
2000
..........................
SENATE BILL 1043
AN ACT
AMENDING TITLE 36, CHAPTER 1, ARTICLE 2, ARIZONA REVISED STATUTES, BY ADDING SECTION
36-142; RELATING TO THE DEPARTMENT OF HEALTH SERVICES.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 1, article 2, Arizona Revised Statutes, is amended by adding section 36-142, to read:
36-14? Prostate cancer task force; membership; duties; program termination
A. THE PROSTATE CANCER TASK FORCE IS ESTABLISHED CONSISTING OF THE FOLLOWING
MEMBERS:
I. THE DIRECTOR OF THE CANCER RESEARCH INSTITUTE AT ARIZONA STATE UNIVERSITY OR
THE DIRECTOR'S DESIGNEE. THIS MEMBER SHALL ACT AS CHAIRPERSON OF THE TASK FORCE IN
ODD-NUMBERED YEARS.
2. THE DIRECTOR OF THE ARIZONA CANCER CENTER AT THE UNIVERSITY OF ARIZONA OR THE
DIRECTOR'S DESIGNEE. THIS MEMBER SHALL ACT AS CHAIRPERSON OF THE TASK FORCE IN
EVEN-NUMBERED YEARS.
3 THE CHAIRPERSON OF THE ARIZONA DISEASE CONTROL RESEARCH COMMISSION OR A
MEMBER OF THAT COMMISSION DESIGNATED BY ITS CHAIRPERSON.
4. THE FOLLOWING MEMBERS WHO ARE APPOINTED BY THE GOVERNOR:
(a) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO
SPECIALIZES IN UROLOGY.
(b) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO
SPECiALlZES IN ONCOLOGY.
(c) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO
SPECIALIZES IN RADIATION ONCOLOGY.
(d) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO
SPECIALIZES IN INTERNAL MEDICINE.
(e) A PERSON WHO REPRESENTS A STATEWIDE ORGANIZATION THAT PROMOTES CANCER
AWARENESS.
( f ) TWO SURVIVORS OF PROSTATE CANCER.
(g) TWO REPRESENTATIVES OF THE BUSINESS COMMUNITY.
(h) TWO PUBLTC MEMBERS WITH A DEMONSTRATED INTEREST IN THE AREA OF EDUCATING THE
PUBLIC REGARDING THE RISKS AND PREVENTION OF CANCER.
5. TWO SURVIVORS OF PROSTATE CANCER. THE PRESIDENT OF THE SENATE AND THE SPEAKER
OF THE HOUSE OF REPRESENTATIVES SHALL EACH APPOINT ONE OF THESE MEMBERS.
6. TWO PUBLIC MEMBERS WITH A DEMONSTRATED INTEREST IN THE AREA OF EDUCATING THE
PUBLIC REGARDING THE RISKS AND PREVENTION OF CANCER. THE PRESIDENT OF THE SENATE
AND THE SPEAKER OF THE HOUSE OF REPRESENTATIVES SHALL EACH APPOINT ONE OF THESE
MEMBERS.
B. THE TASK FORCE SHALL:
1. MEET AT LEAST FOUR TIMES A YEAR AND AT THE CALL OF THE CHAIRPERSON.
2. COLLECT RESEARCH AND INFORMATION ON PROSTATE CANCER.
@ 3. EVALUATE VARIOUS APPROACHES USED BY STATE AND LOCAL GOVERNMENTS TO INCREASE
PUBLIC AWARENESS OF THE RISK, TREATMENT AND PREVENTION OF PROSTATE CANCER.
Arizona Prostate Cancer Task Force Report
4. STUDY WAYS TO IMPROVE COORDINATION BETWEEN AGENCIES AND INSTITUTIONS THAT ARE
INVOLVED IN RESEARCH AND TREATMENT OF PROSTATE CANCER.
5. STUDY WAYS TO INCREASE RESEARCH AND FUNDING AT STATE INSTITUTIONS THAT ARE
STUDYING CANCER.
6. STUDY WAYS TO INCREASE THE NUMBER OF MEN IN THIS STATE WHO ARE REGULARLY
SCREENED FOR PROSTATE CANCER.
7. IDENTIFY AREAS WHERE PUBLIC AWARENESS, PUBLIC EDUCATION, RESEARCH AND
COORDINATION ABOUT PROSTATE CANCER NEED IMPROVEMENT.
8. SUBMIT AN ANNUAL REPORT OF ITS FINDINGS AND RECOMMENDATIONS TO THE GOVERNOR,
THE SPEAKER OF THE HOUSE OF REPRESENTATIVES AND THE PRESIDENT OF THE SENATE ON OR
BEFORE NOVEMBER 15. THE TASK FORCE SHALL PROVIDE A COPY OF ITS REPORT TO THE
SECRETARY OF STATE AND THE DIRECTOR OF THE DEPARTMENT OF LIBRARY, ARCHIVES AND
PUBLIC RECORDS.
C. MEMBERS WHO SERVE PURSUANT TO SUBSECTION A, PARAGRAPHS 1 AND 2 OF THIS SECTION
SERVE FIVE YEAR TERMS AND MAY SERVE ONE ADDITIONAL TERM.
D. TASK FORCE MEMBERS ARE NOT ELIGIBLE TO RECEIVE COMPENSATION BUT MEMBERS WHO
SERVE PURSUANT TO SUBSECTION A, PARAGRAPHS 1 AND 2 OF THIS SECTION ARE ELIGIBLE TO
RECEIVE REIMBURSEMENT OF EXPENSES PURSUANT TO TlTLE 38, CHAPTER 4, ARTICLE 2 FROM
THEIR EMPLOYERS.
E. THE PROGRAM ESTABLISHED BY THIS SECTION ENDS ON JULY 1,2010 PURSUANT TO SECTION
41-3102.
Sec. 2. Initial terms of appointed members of the prostate cancer task force
A. Notwithstanding section 36-142, Arizona Revised Statutes, as added by this act, the initial terms of appointed
members are:
1. Two terms ending January 1, 2002.
2. Two terms ending January 1,2003.
3. Four terms ending January 1,2004. @ 4. Five terms ending January 1, 2005.
B. The governor, the speaker of the house of representatives and the president of the senate shall make all
subsequent appointments as prescribed by statute.
Sec. 3. Emergency
This act is an emergency measure that is necessary to preserve the public peace, health or safety and is operative
immediately as provided by law.
Arizona Prostate Cancer Task Force Report
Prostate Cancer Task Force Members
G. Robert Pettit, Ph.D. Director, Cancer Research Institute, ASU
Daniel Von Hoff, M.D., F.A.C.P. Director, Arizona Cancer Center, UA
Henry Reeves, Ph.D. Chair, Arizona Disease Control Research Commission
Governor Appointees
C. Gilberto Brito, M.D.
Tom Fitch, M.D.
Gordon Grado, M.D.
Art Mollen, D.O.
April Becker
Bert Chamberland, Ph.D.
Samuel Arutt
Gloria Sanak
Philip Poling
Rex Zeiger
Norman L. Miller
@ Speaker of House Appointees
Gregory Muhammad, M.D.
Appointment Area
Urology Specialist
Oncology Specialist
Radiation Oncology Specialist
Internal Medicine Specialist
Statewide Organization Promoting Awareness
Prostate Cancer Survivor
Prostate Cancer Survivor
Representative of Business Community
Representative of Business Community
Public Education - Cancer Risk and Prevention
Public Education - Cancer Risk and Prevention
Appointment Area
Public Education - Cancer Risk and Prevention
Ralph Valle Prostate Cancer Survivor
President of Senate Appointees Appointment Area
Sidney Rosen Public Education - Cancer Risk and Prevention
Gene Felker Prostate Cancer Survivor
Arizona Prostate Cancer Task Force Report
Prostate Cancer Taskforce Meeting Minutes
The inaugural meeting of the Prostate Cancer Task Force was held on Thursday, September 14,2000,
from noon to 2 p.m. at the Cancer Research Institute, Room 15 1, on the Arizona State University
Campus.
Members Present:
Samuel Arutt,
April Becker
Gil Brito, M.D.
Bert Chamberland, Ph.D.
Gene Felker
Tom Fitch, M.D.
Gordon Grado, M.D.
Art Mollen, D.O.
Members Absent:
Lee Miller
Greg Muhammad, M.D.
Philip Poling
Henry Reeves
Sidney Rosen
Gloria Sanak
Ralph Valle
Daniel Von Hoff. M.D., F.A.C.P
Rex Zeiger
G. Robert Pettit, Ph.D.
Attending for Members:
Jack Knight, Ph.D. for G. Robert Pettit, Ph.D.
@ Guests: Judy Bemas (University of Arizona College of Medicine)
~ r i a ~n c ~ n a l l(e~nm ericanC ancer society)
Robert Byars (Cancer Research Institute, Arizona State University (ASU))
Dr. Michael Gordon (Arizona Health Sciences Center, Phoenix Campus)
Jack Knight (Cancer Research Institute, ASU)
Robin Pettit (Cancer Research Institute, ASU)
Laurie Young (Arizona Cancer Center)
Facilitator:
Daniel Von Hoff, M.D., F.A.C.P.
Introductions and Certzjicate Distribution
The meeting began with a welcome from Dr. Von Hoff. He then asked everyone to introduce themselves ,
briefly describe their experience with prostate cancer and what they hope to see the task force accomplish.
Certificates from the Governor's Office were distributed to those members appointed by the Governor.
Charge from the Governor/Legislature
Dr. Von Hoff presented an overview of the incidence and mortality rates for prostate cancer in Arizona.
He then reviewed the mission of the task force as outlined in the legislation. There was a brief discussion
of the task force requirements and the fact that this is an unfunded mandate.
Arizona Prostate Cancer Task Force Report
Possible Methods to Approach the Charge
@ The Task Force agreed on a goal: To reduce the mortality ofprostate cancer by 50percent overfive
years and by 90percent over the next decade. To accomplish this goal, establishing working teams to
address areas of focus were recommended. The following teams were formed and members volunteered
to serve on one or more team.
Research Team
Team Leader: Michael Gordon
Team Members: Robin Pettit, Dan Von Hoff, Ralph Valle, Gordon Grado, Tom Fitch
Gil Brito, Sid Rosen, Gloria Sanak, Brian McAnallen
Action items: Establish a Prostate Cancer Tumor Bank (ADCRC Grant), study
protective benefits among Hispanic Men, "Keep the Tissue" legislation
to save tumor blocks, clinical trials for relapsing patients.
Ways and Means Team
Team Leader: Gene Felker
Team Members: April Becker, Gordon Grado, Gil Brito, Philip Poling
Action items: Fund raising opportunities, creation of an "Arizona Prostate Cancer
Action Plan (similar to New Jersey and Florida plans).
Informatics Team
Team Leader: Ralph Valle
Team Members: Gregory Muhammad, Art Mollen, Gene Felker, Samuel Arutt,
April Becker, Gordon Grado, Tom Fitch, Rex Zeiger, Bert Chamberland
Action Plan: Establish a web site with local clinical trials information, promote the
new SELECT study, increase awareness, increase usage of PSA, Prostate
Cancer Awareness Month, create a speakers bureau, prostate partners
plan (survivors and doctors meet with new patients).
Team leaders will organize their teams meetings. Team reports will be due to Dr. Von Hoff on Monday,
October 30,2000. From these team reports, a final report from the Task Force will be delivered to the
Governor's office by Wednesday, November 15,2000. It was proposed that the report be hand-delivered
to the Governor, the President of the Senate and the Speaker of the House by Dr. Von Hoff and the
Working Team Chairs. Further discussion of this recommendation will be done by phone as Nov. 15
approaches.
Another Meeting of the Task Force will be planned following the Nov. 15 deadline of the Task Force
Report to the Governor.
ADDENDUM TO THE MINUTES:
April Becker was asked by Gene Felker to replace him as Team Leader for the Ways and Means Team.
US TOO Prostate
-st Prostate Cmcer FoLmdatmn, and the
Sadhwst DNism of the Amencan Ca deckated to pnxmbng awareness, infonatron and
assistance to Anuxra's cibzens of this dre
i,' 2
MW,T HEREFORE, I, Jane Dee M, ~ o u h r && State of Arizona, do hemby prodakn September,
MOO as : fjd
; 3
PROSTATE C~WMAW ARENEW MWlli
=.
IN WTNESS WHEREOf, I have tmretmto set my hand and
cacfted to be Mixed the Great Seal of the State of Arizona I
/ . GOVERNOR
DONE at #e Qpii in PMenix on this eleventh day of
September in the vear Two Thousand and of the
? ~nde~endencoef the-united States of America the Two I
Hundred and Twenty-fowth. I